Employee Education Meeting For members of Advantage Health Plans Trust
AHP not an Insurance Carrier • Owned/Operated by Community Banks • Self-Funded • YOU own it! • Every dollar saved helps to lower costs! -5 -4 -3 -2 -1 0 +1 +2 3 4 Better Risk Worse Risk
What is Self-Funding? Employers take on the 60%+ of all employee 100% funded by Driving the buyer’s risk of their employees’ benefits are paid by employer/employee side of the free market claims expenses self-funded Plan movement
2019 Benefit Enhancements • All inclusive office visit Now includes minor “procedures” under the office visit copay benefit for • applicable plan designs. • Increased limit on physical / manipulative therapy / chiropractic Reimbursement increased $75 to $95 per visit. • • Physical therapy after surgery Now subject to physical/manipulative therapy/chiropractic benefit above. • • CPAP replacement supplies are now covered Through KPPFree. • OR Expenses related to equipment or replacement CPAP supplies may be • covered based on patient compliance / Medical Necessity Review.
2019 Benefit Enhancements • Hearing Loss Services & Devices Covered if due to injury or illness up to $2,500 each. • Limited to 1 device per lifetime. • If under 18 years of age, limitations may be waived based on medical • necessity review. Not covered if due to sensorineural hearing loss. • • ACA Mandated Preventive Services w/ Age Limits Screening colonoscopy, bone density scan, screening mammogram covered • prior to ACA age limit. Same frequency limitations apply • Under ACA age minimum - deductible & coinsurance • Above ACA age minimum - 100% •
AHP ID Cards
The Network Problem Win when No Discounts Accountability Claims $$$ “Discount Off “billed” No True Cost Skimming” Retains What is No True Portion of “billed?” Quality Discount
Network Discounts Vs. Cash/Free Market Price
The Fix – Protecting our Plan KPP Free™ Education, Making Better Incentives, and Healthcare 100% Covered Tools to Help You Buying Choice Medical Services Orthopedic, Imaging, General, Urology, ENT, Gynecology, Oncology, Cardiac, Bariatric, Digestive, Eye, Pain Management, Physical Therapy, Sleep, and more!
Patient Calls Kempton Care Advocates. Easy as Patient Shows KPP Free™ 1-2-FREE! Voucher At Appointment. Procedure Or Service Is Covered At 100%!
AHP KPP Free TM Locations
KPP Free™ Savings
AHP KPP FREE TM Statistics Total KPP FREE TM Savings 2018 KPP FREE TM Savings KPP FREE TM Details (3/1/2012-6/30/2018) (1/1/2018-6/30/2018) 82 Free Market Facilities 7,105 Procedures Performed 1,006 Procedures Performed Surgery centers and hospitals in 11 states Total Number of Procedures Total Number of Procedures in 2018 156 Facility Locations $14,775,628 Million Saved $1,769,797 Million Saved Facility locations in 46 states Total Savings - 3/1/2012- 6/30/2018 Total Savings - 1/1/2018- 6/30/2018 2,500 Imaging Centers $2,080 Average Saved $1,759 Average Saved KPPFree & OneCall locations in 46 states Average amount saved per claim Average amount saved per claim 100+ Prospects $153,987 Highest Saved $92,587 Highest Saved Prospective KPPFree Providers in 20 states Highest amount saved in a single claim Highest amount saved in a single claim 2,000 services 26 Cash Price Agreements 110 Cash Price Agreements Procedures, imaging, tests, & treatments Agreements with local providers who Agreements with local providers who price match the KPPFree price price match the KPPFree price 600+ Claims Processed Average number of claims processed monthly
Cash Price Agreements • Any provider can match the KPP Free™ price. • Members negotiate with their current provider to get a better deal, and 100% coverage, while staying with their current provider. • If you want a Cash Price Agreement, just call us!
More 100% Benefits DIAGNOSTIC IMAGING LABORATORY OTC MEDICATIONS • OneCall • LabCard • Specific over-the-counter medications • MRI’s • DLO • Heartburn • CAT • Quest Diagnostics • Allergy • PET scans • CPL • Option for when KPP Free™ • Any Lab Test Now provider is not available.
Diagnostic Colonoscopy $200 Upper GI Endoscopy Go Green to Get Green Sleep Study $100 Cataract Surgery Rewards! Heart Perfusion Imaging Doppler Exam of the Heart $50 Heart Echo Download the HCBB app!
Medical Services with Reference Based Limits Intraoperative Implantable Dialysis Out-of-Network Nerve Air Ambulance Medical Devices Monitoring PHYSICIAN The provider’s Invoice cost Medicare Rate + 100% + 20% The provider’s The provider’s FACILITY Limited to Medicare Rate Medicare Rate The provider’s $4,000 + 20% + 140% Medicare Rate If invoice is not + 50% provided, Administrator may use an EMERGENCY alternate The provider’s Reference Medicare Rate + 100%
AHP Participant Spine - Artificial Cervical Disc Implant Only
Talking to Your Physician about Cost How much will this My health plan is What do you Would you be My health plan treatment cost? I self-funded. I want charge/how much willing to match the reimburses a would like to know to keep cost in does this treatment bundled price that percentage above what the total cost mind when I am cost? is available to me your Medicare rate will be, not just my making this through my plan? for this service. I have a better out-of-pocket cost? decision. benefit if the cost is I would save Are you willing to reasonable. significant money accept this on my out-of-pocket reimbursement costs. without balance billing? If not, how much would you accept?
ID Card Sleeves
Secure Web Portal • View detailed claim information and out-of-pocket details • Download out-of-pocket reports into CSV/Excel • Find information about your benefits • View & Print flyers, handouts, and forms • Download our mobile app for iPhone and Android: KemptonNOW
www.advantagehealthplans.com 1 (800) 324-9396
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